Compulsivity in anorexia nervosa: a transdiagnostic concept

Abstract

The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive–compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.

An investigation of habit learning in Anorexia Nervosa

“…These distorted beliefs and perceptions are accompanied by a perpetual drive for thinness and continuous lowering of weight goals (Barbarich-Marsteller et al, 2011). The characteristic behaviours seen in AN to achieve weight-loss goals, such as extreme dietary restriction and over-exercise, have been described as evidence of the compulsive nature of the disorder (Godier and Park, 2014a; Park et al, 2014). Furthermore, individuals with AN show cognitive inflexibility (Tchanturia et al, 2004), a rigid cognitive style suggested to contribute to compulsivity (Fineberg et al, 2010).…”

“…This can be seen in repetitive, and highly ritualised behaviours of OCD, which impair patients ability to engage in normal daily activities (American Psychiatric Association, 2013), and in the lack of control felt over drug-seeking behaviour in substance dependence, despite the adverse consequences (Kalivas and Volkow, 2005). Compulsive behaviour in AN has been compared to both OCD (Steinglass and Walsh, 2006), and addiction (Barbarich-Marsteller et al, 2011; Godier and Park, 2014a, b, 2015; Kaye et al, 2013; Park et al, 2014; Scheurink et al, 2010; Zink and Weinberger, 2010). Indeed, studies using the Iowa Gambling task in participants with AN, OCD and substance dependence, suggest in all three disorders a tendency to make disadvantageous decisions when choosing between immediate or long terms gains (Lawrence et al, 2006; Tchanturia et al, 2007; Verdejo-Garcia et al, 2007), which may be linked to the compulsive, self-destructive and sometimes impulsive behaviours seen across these disorders (Tchanturia et al, 2007).…”

Emotional Well-Being in Anorexia Nervosa: Negative Affect, Sleeping Problems, Use of Mood-enhancing Drugs and Exercise Frequency

“…Extent of physical exercise was correlated with trait reward sensitivity, engagement and attentional orienting. However, the finding, in AN patients, of a positive relationship between excessive exercise and obsessive compulsive disorder is unsettling [43,44], have implied that excessive habit formation, the exercise habit, may be construed as a mechanism through which initially rewarding weight loss behavior in AN may develop a compulsiveness over time, with supervised exercise training deemed as 'safe' [45]. AN has been shown to cooccur with obsessive-compulsive disorder and depression [46].…”

Neurobiological bases for impulsive and compulsive behaviour: Implications for pharmacological and psychological interventions

“…Anoreksija nervoza i zavisnost od supstance takođe imaju i kompulzivne karakteristike. Anoreksiju nervozu karakteriše kompulzivan gubitak telesne težine izražen kroz restrikciju unošenja hrane i preterane fizičke vežbe, ali i epizode prekomernog unošenja hrane [17]. Kompulzivno seksualno ponašanje se karakteriše perzistentnim i repetivnim seksualnm impulsima koji se doživljavaju kao neodoljivi i nekontrolabilni, vodeći repetitivnom seksualnom ponašanju koje postaje centralni focus života osobe, sa neuspešnim naporima da se zaustavi ili redukuje, uprkos posledicama [18].…”